Plastic pollution and infectious diseases
Authors: Pierre-Olivier Maquart, Yves Froehlich, Sebastien Boyer
Journal: The Lancet Planetary Health (2022)

The versatility and resistance of plastic allowed for its massive use during the second half of the 20th century. Plastic is hardly degradable and—because waste management is often inefficient—around 55% ends up either in landfill or in nature. Plastic mismanagement thus durably pollutes the environment. Although several studies have pointed out the effect of microplastic and nanoplastic pollution on global health, few have focused on the effect of macroplastics on the proliferation and propagation of infectious diseases and thus on human and livestock health. Plastic debris that holds water can encourage arthropod-borne disease by providing a habitat for some vectors' immature stages and shelter to anthropophilic and medically important species, potentially increasing local vector populations with implications for disease burden. Similarly, by acting as a stagnant water reservoir, waste plastic promotes the development of pathogenic bacteria (such as leptospirosis) and harmful algae. These microorganisms can produce biofilms, coating plastic fragments that can then colonise new water bodies. These concerns point to the need for a transdisciplinary approach to understand and potentially prevent plastic debris from influencing local vector-borne and waterborne diseases.Plastic, considered a miracle product of the 20th century, has become the curse of the 21st century. Its large-scale production only dates back to the 1950s.1Evode N Qamar SA Bilal M Barceló D Iqbal HMN Plastic waste and its management strategies for environmental sustainability.Case Stud Chem Environ Eng. 2021; 4100142Google Scholar Its annual production exponentially increased from 2 million metric tons (Mt) in 1950 to 381 Mt in 2015.2Geyer R Jambeck JR Law KL Production, use, and fate of all plastics ever made.Sci Adv. 2017; 3e1700782Google Scholar The versatility and resistance offered by this synthetic material made it highly attractive for many applications such as in the food sector, where single-use plastic helps to reduce food waste generation by improving food safety and shelf life of the products.2Geyer R Jambeck JR Law KL Production, use, and fate of all plastics ever made.Sci Adv. 2017; 3e1700782Google Scholar This low-cost and effective product allowed for a globalised economy, in which fabrication happens further and further away from the consumer, facilitated by more and more wrapping and packing materials.1Evode N Qamar SA Bilal M Barceló D Iqbal HMN Plastic waste and its management strategies for environmental sustainability.Case Stud Chem Environ Eng. 2021; 4100142Google Scholar, 3Zhao X Korey M Li K et al.Plastic waste upcycling toward a circular economy.Chem Eng J. 2022; 428131928Google Scholar As a consequence, the packaging sector is the largest producer of plastic waste, accounting for nearly half of plastic waste generation.1Evode N Qamar SA Bilal M Barceló D Iqbal HMN Plastic waste and its management strategies for environmental sustainability.Case Stud Chem Environ Eng. 2021; 4100142Google Scholar, 2Geyer R Jambeck JR Law KL Production, use, and fate of all plastics ever made.Sci Adv. 2017; 3e1700782Google Scholar In 2015, of the 302 Mt of plastic waste generated, 141 Mt were solely attributed to this sector. The plastic waste generated is often of single use, and is characterised by a short use lifetime, usually less than 6 months.4Jambeck JR Geyer R Wilcox C et al.Marine pollution. Plastic waste inputs from land into the ocean.Science. 2015; 347: 768-771Google Scholar In 2015, 20% of global plastic waste was recycled, 25% was incinerated, and 55% was either put into landfills or discarded in nature.1Evode N Qamar SA Bilal M Barceló D Iqbal HMN Plastic waste and its management strategies for environmental sustainability.Case Stud Chem Environ Eng. 2021; 4100142Google Scholar, 3Zhao X Korey M Li K et al.Plastic waste upcycling toward a circular economy.Chem Eng J. 2022; 428131928Google ScholarMismanagement of plastic waste is generally most evident in middle-income countries, especially in tropical areas (with the addition of China). These countries have usually faced a rapid development and many import large volumes of plastic waste from high-income countries; however, their waste management systems are not able to cope with these large volumes of plastic.3Zhao X Korey M Li K et al.Plastic waste upcycling toward a circular economy.Chem Eng J. 2022; 428131928Google Scholar, 4Jambeck JR Geyer R Wilcox C et al.Marine pollution. Plastic waste inputs from land into the ocean.Science. 2015; 347: 768-771Google Scholar, 5UN Environment ProgrammeSingle-use plastics, a roadmap for sustainability.https://www.unep.org/resources/report/single-use-plastics-roadmap-sustainabilityDate: 2018Date accessed: September 3, 2021Google Scholar If current production and plastic waste management practices continue, about 12 000 Mt of plastic waste will end up in landfills or in the natural environment by 2050.2Geyer R Jambeck JR Law KL Production, use, and fate of all plastics ever made.Sci Adv. 2017; 3e1700782Google Scholar, 6Chen HL Nath TK Chong S Foo V Gibbins C Lechner AM The plastic waste problem in Malaysia: management, recycling and disposal of local and global plastic waste.SN Appl Sci. 2021; 3: 437Google ScholarGlobal plastic waste mismanagement is causing a serious predicament as it interacts with wildlife in several ways.7Brach L Deixonne P Bernard MF et al.Anticyclonic eddies increase accumulation of microplastic in the North Atlantic subtropical gyre.Mar Pollut Bull. 2018; 126: 191-196Google Scholar, 8Law KL Plastics in the marine environment.Annu Rev Mar Sci. 2017; 9: 205-229Google Scholar, 9Rochman CM Strategies for reducing ocean plastic debris should be diverse and guided by science.Environ Res Lett. 2016; 11041001Google Scholar It can constrict or trap animals, be ingested, or directly affect the environment by its presence, such as by reducing oxygenation in the water, lowering light penetration, or covering coral reefs.7Brach L Deixonne P Bernard MF et al.Anticyclonic eddies increase accumulation of microplastic in the North Atlantic subtropical gyre.Mar Pollut Bull. 2018; 126: 191-196Google Scholar, 8Law KL Plastics in the marine environment.Annu Rev Mar Sci. 2017; 9: 205-229Google Scholar Due to its resistance, it is not—or is barely—degradable and instead breaks down into smaller particles that are easily carried away into aquatic environments.1Evode N Qamar SA Bilal M Barceló D Iqbal HMN Plastic waste and its management strategies for environmental sustainability.Case Stud Chem Environ Eng. 2021; 4100142Google Scholar The ever-growing problem of microplastics and the marine environment is well documented.6Chen HL Nath TK Chong S Foo V Gibbins C Lechner AM The plastic waste problem in Malaysia: management, recycling and disposal of local and global plastic waste.SN Appl Sci. 2021; 3: 437Google Scholar, 10Li L Zuo J Duan X Wang S Hu K Chang R Impacts and mitigation measures of plastic waste: a critical review.Environ Impact Assess Rev. 2021; 90106642Google Scholar Many studies focus on microplastic and nanoplastic's effects as endocrine disruptors,1Evode N Qamar SA Bilal M Barceló D Iqbal HMN Plastic waste and its management strategies for environmental sustainability.Case Stud Chem Environ Eng. 2021; 4100142Google Scholar, 3Zhao X Korey M Li K et al.Plastic waste upcycling toward a circular economy.Chem Eng J. 2022; 428131928Google Scholar, 11Cole M Lindeque P Fileman E Halsband C Galloway TS The impact of polystyrene microplastics on feeding, function and fecundity in the marine copepod Calanus helgolandicus.Environ Sci Technol. 2015; 49: 1130-1137Google Scholar or in a broader sense their influence on both human and wildlife health.7Brach L Deixonne P Bernard MF et al.Anticyclonic eddies increase accumulation of microplastic in the North Atlantic subtropical gyre.Mar Pollut Bull. 2018; 126: 191-196Google Scholar, 11Cole M Lindeque P Fileman E Halsband C Galloway TS The impact of polystyrene microplastics on feeding, function and fecundity in the marine copepod Calanus helgolandicus.Environ Sci Technol. 2015; 49: 1130-1137Google Scholar For example, microplastics were found ontogenically transferred from the larvae to the adult mosquito12Al-Jaibachi R Cuthbert RN Callaghan A Up and away: ontogenic transference as a pathway for aerial dispersal of microplastics.Biol Lett. 2018; 1420180479Google Scholar and fragments could be transmitted through the bite of a female mosquito.13Gopinath PM Darekar AS Kanimozhi S Mukherjee A Chandrasekaran N Female mosquito-a potential vector for transporting plastic residues to humans.Chemosphere. 2022; 301134666Google Scholar The most noticeable and reported consequences of plastic pollution are the great Pacific garbage patch, and casualties amongst turtles and large mammals after plastic entanglement or ingestion.7Brach L Deixonne P Bernard MF et al.Anticyclonic eddies increase accumulation of microplastic in the North Atlantic subtropical gyre.Mar Pollut Bull. 2018; 126: 191-196Google Scholar Most research articles focus on the effect of plastic debris in marine or aquatic environments.8Law KL Plastics in the marine environment.Annu Rev Mar Sci. 2017; 9: 205-229Google Scholar, 9Rochman CM Strategies for reducing ocean plastic debris should be diverse and guided by science.Environ Res Lett. 2016; 11041001Google Scholar Surprisingly, there are few studies on macroplastics and their effects in terrestrial environments. In this article, we emphasise the potential role of plastic pollution on infectious disease risk. Several studies have targeted the effect of rubbish and solid waste accumulation on infectious disease risks taking a One Health approach.14Abeyewickreme W Wickremasinghe AR Karunatilake K Sommerfeld J Axel K Community mobilization and household level waste management for dengue vector control in Gampaha district of Sri Lanka; an intervention study.Pathog Glob Health. 2012; 106: 479-487Google Scholar, 15Alam P Ahmade K Impact of solid waste on health and the environment.Int J Sustain Dev Green Econ. 2013; 2: 165-169Google Scholar, 16Alirol E Getaz L Stoll B Chappuis F Loutan L Urbanisation and infectious diseases in a globalised world.Lancet Infect Dis. 2011; 11: 131-141Google Scholar, 17Banerjee S Aditya G Saha GK Household disposables as breeding habitats of dengue vectors: linking wastes and public health.Waste Manag. 2013; 33: 233-239Google Scholar, 18Costa CHN Werneck GL Rodrigues Jr, L et al.Household structure and urban services: neglected targets in the control of visceral leishmaniasis.Ann Trop Med Parasitol. 2005; 99: 229-236Google Scholar, 19Sarkar U Nascimento SF Barbosa R et al.Population-based case-control investigation of risk factors for leptospirosis during an urban epidemic.Am J Trop Med Hyg. 2002; 66: 605-610Google Scholar, 20Lima ID Lima ALM Mendes-Aguiar CO et al.Changing demographics of visceral leishmaniasis in northeast Brazil: lessons for the future.PLoS Negl Trop Dis. 2018; 12e0006164Google Scholar, 21Milke M Plague in Sydney and its solid waste lessons.Waste Manag. 2004; 24: 321-323Google Scholar, 22Tana S Umniyati S Petzold M Kroeger A Sommerfeld J Building and analyzing an innovative community-centered dengue-ecosystem management intervention in Yogyakarta, Indonesia.Pathog Glob Health. 2012; 106: 469-478Google Scholar, 23Vallée J Thaojaikong T Moore CE et al.Contrasting spatial distribution and risk factors for past infection with scrub typhus and murine typhus in Vientiane City, Lao PDR.PLoS Negl Trop Dis. 2010; 4: e909Google Scholar However, they often lacked standardised procedures24Krystosik A Njoroge G Odhiambo L Forsyth JE Mutuku F LaBeaud AD Solid wastes provide breeding sites, burrows, and food for biological disease vectors, and urban zoonotic reservoirs: a call to action for solutions-based research.Front Public Health. 2020; 7: 405Google Scholar and rarely provide information on waste composition.Plastic pollution and accumulation are rarely taken into account in infectious diseases studies. However, such pollution can directly influence arthropod-borne diseases by generating suitable habitats for their vectors (figure). The most obvious examples are Aedes aegypti and Aedes albopictus mosquitoes, transmitting chikungunya, dengue, yellow fever, and Zika viruses along with numerous other arboviruses.25Brady OJ Hay SI The global expansion of dengue: how Aedes aegypti mosquitoes enabled the first pandemic arbovirus.Annu Rev Entomol. 2020; 65: 191-208Google Scholar, 26Fontenille D Powell JR From anonymous to public enemy: how does a mosquito become a feared arbovirus vector?.Pathogens. 2020; 9: 265Google Scholar Both species are known to be highly anthropophilic and to develop in plastic containers,17Banerjee S Aditya G Saha GK Household disposables as breeding habitats of dengue vectors: linking wastes and public health.Waste Manag. 2013; 33: 233-239Google Scholar, 27Boornema AR Senthil Murugan TK Breeding habitats of Aedes aegypti mosquitoes and awareness about prevention of dengue in urban Chidambaram: a cross sectional study.Int J Community Med Public Health. 2018; 54584Google Scholar, 28Alencar CHM Infestation by Aedes albopictus (Skuse) in natural and artificial breeding sites found in green areas in the city of Fortaleza, Ceará.J Venom Anim Toxins Incl Trop Dis. 2009; 15: 1Google Scholar, 29Banerjee S Aditya G Saha GK Household wastes as larval habitats of dengue vectors: comparison between urban and rural areas of Kolkata, India.PLoS One. 2015; 10e0138082Google Scholar, 30Chen WJ Dengue outbreaks and the geographic distribution of dengue vectors in Taiwan: a 20-year epidemiological analysis.Biomed J. 2018; 41: 283-289Google Scholar, 31Getachew D Tekie H Gebre-Michael T Balkew M Mesfin A Breeding sites of Aedes aegypti: potential dengue vectors in Dire Dawa, East Ethiopia.Interdiscip Perspect Infect Dis. 2015; 2015706276Google Scholar, 32Kusumawathie PHD Fernando WP Breeding habitats of Aedes aegypti Linnaeus and Ae albopictus Skuse in a dengue transmission area in Kandy, Sri Lanka.Ceylon J Med Sci. 2003; 46: 51Google Scholar, 33MacCormack-Gelles B Lima Neto AS Sousa GS et al.Epidemiological characteristics and determinants of dengue transmission during epidemic and non-epidemic years in Fortaleza, Brazil: 2011-2015.PLoS Negl Trop Dis. 2018; 12e0006990Google Scholar, 34Rao BB George B Breeding patterns of Aedes stegomyia albopictus in periurban areas of Calicut, Kerala, India.Southeast Asian J Trop Med Public Health. 2010; 41: 536-540Google Scholar, 35Rohani A Aidil Azahary AR Malinda M et al.Eco-virological survey of Aedes mosquito larvae in selected dengue outbreak areas in Malaysia.J Vector Borne Dis. 2014; 51: 327-332Google Scholar, 36Vijayakumar K Sudheesh Kumar TK Nujum ZT Umarul F Kuriakose A A study on container breeding mosquitoes with special reference to Aedes (Stegomyia) aegypti and Aedes albopictus in Thiruvananthapuram district, India.J Vector Borne Dis. 2014; 51: 27-32Google Scholar, 37Vikram K Nagpal BN Pande V et al.Comparison of Ae. aegypti breeding in localities of different socio-economic groups of Delhi, India.Int J Mosquito Res. 2015; 2: 83-88Google Scholar, 38Ramos MM Mohammed H Zielinski-Gutierrez E et al.Epidemic dengue and dengue hemorrhagic fever at the Texas-Mexico border: results of a household-based seroepidemiologic survey, December 2005.Am J Trop Med Hyg. 2008; 78: 364-369Google Scholar tyres,28Alencar CHM Infestation by Aedes albopictus (Skuse) in natural and artificial breeding sites found in green areas in the city of Fortaleza, Ceará.J Venom Anim Toxins Incl Trop Dis. 2009; 15: 1Google Scholar, 31Getachew D Tekie H Gebre-Michael T Balkew M Mesfin A Breeding sites of Aedes aegypti: potential dengue vectors in Dire Dawa, East Ethiopia.Interdiscip Perspect Infect Dis. 2015; 2015706276Google Scholar, 32Kusumawathie PHD Fernando WP Breeding habitats of Aedes aegypti Linnaeus and Ae albopictus Skuse in a dengue transmission area in Kandy, Sri Lanka.Ceylon J Med Sci. 2003; 46: 51Google Scholar, 36Vijayakumar K Sudheesh Kumar TK Nujum ZT Umarul F Kuriakose A A study on container breeding mosquitoes with special reference to Aedes (Stegomyia) aegypti and Aedes albopictus in Thiruvananthapuram district, India.J Vector Borne Dis. 2014; 51: 27-32Google Scholar, 39Espinosa M Weinberg D Rotela CH Polop F Abril M Scavuzzo CM Temporal dynamics and spatial patterns of Aedes aegypti breeding sites, in the context of a dengue control program in Tartagal (Salta Province, Argentina).PLoS Negl Trop Dis. 2016; 10e0004621Google Scholar, 40Jain J Kushwah RBS Singh SS et al.Evidence for natural vertical transmission of chikungunya viruses in field populations of Aedes aegypti in Delhi and Haryana states in India-a preliminary report.Acta Trop. 2016; 162: 46-55Google Scholar, 41Ngugi HN Mutuku FM Ndenga BA et al.Characterization and productivity profiles of Aedes aegypti (L.) breeding habitats across rural and urban landscapes in western and coastal Kenya.Parasit Vectors. 2017; 10: 331Google Scholar buckets,41Ngugi HN Mutuku FM Ndenga BA et al.Characterization and productivity profiles of Aedes aegypti (L.) breeding habitats across rural and urban landscapes in western and coastal Kenya.Parasit Vectors. 2017; 10: 331Google Scholar plastic teacups,40Jain J Kushwah RBS Singh SS et al.Evidence for natural vertical transmission of chikungunya viruses in field populations of Aedes aegypti in Delhi and Haryana states in India-a preliminary report.Acta Trop. 2016; 162: 46-55Google Scholar, 42Hiriyan J Tewari SC Tyagi BK Aedes albopictus (Skuse) breeding in plastic cups around tea-vendor spots in Ernakulam City, Kerala State, India.Dengue Bulletin. 2003; 49: 2-9Google Scholar and plastic bottles28Alencar CHM Infestation by Aedes albopictus (Skuse) in natural and artificial breeding sites found in green areas in the city of Fortaleza, Ceará.J Venom Anim Toxins Incl Trop Dis. 2009; 15: 1Google Scholar, 40Jain J Kushwah RBS Singh SS et al.Evidence for natural vertical transmission of chikungunya viruses in field populations of Aedes aegypti in Delhi and Haryana states in India-a preliminary report.Acta Trop. 2016; 162: 46-55Google Scholar and are usually found near households, as observed in Argentina,43Vezzani D Schweigmann N Suitability of containers from different sources as breeding sites of Aedes aegypti (L.) in a cemetery of Buenos Aires City, Argentina.Mem Inst Oswaldo Cruz. 2002; 97: 789-792Google Scholar India,44Rao BB Harikumar PS Jayakrishnan T George B Characteristics of Aedes (Stegomyia) albopictus Skuse (Diptera:Culicidae) breeding sites.Southeast Asian J Trop Med Public Health. 2011; 42: 1077-1082Google Scholar La Reunion Island,45Boyer S Foray C Dehecq JS Spatial and temporal heterogeneities of Aedes albopictus density in La Reunion Island: rise and weakness of entomological indices.PLoS One. 2014; 9e91170Google Scholar Malaysia,46Chen CD Lee HL Stella-Wong SP Lau KW Sofian-Azirun M Container survey of mosquito breeding sites in a university campus in Kuala Lumpur, Malaysia.Dengue Bulletin. 2009; 33: 8Google Scholar the Philippines,47Edillo FE Roble ND Otero 2nd, ND The key breeding sites by pupal survey for dengue mosquito vectors, Aedes aegypti (Linnaeus) and Aedes albopictus (Skuse), in Guba, Cebu City, Philippines.Southeast Asian J Trop Med Public Health. 2012; 43: 1365-1374Google Scholar and Thailand.48Chareonviriyaphap T Akratanakul P Nettanomsak S Huntamai S Larval habitats and distribution patterns of Aedes aegypti (Linnaeus) and Aedes albopictus (Skuse), in Thailand.Southeast Asian J Trop Med Public Health. 2003; 34: 529-535Google Scholar Since these species develop in plastic waste, and considering the large distribution of these highly anthropophilic vector species—mainly across tropical regions, many of which lack effective plastic waste management systems—it is now believed that more than half of the world's population is at risk of Aedes-borne viruses where plastic waste could influence transmission.25Brady OJ Hay SI The global expansion of dengue: how Aedes aegypti mosquitoes enabled the first pandemic arbovirus.Annu Rev Entomol. 2020; 65: 191-208Google Scholar Japanese encephalitis virus vectors, mainly belonging to the Culex genus,49Boyer S Durand B Yean S et al.Host-feeding preference and diel activity of mosquito vectors of the Japanese encephalitis virus in rural Cambodia.Pathogens. 2021; 10: 376Google Scholar do the same appropriation of plastic waste for their immature aquatic stages. In addition to providing suitable breeding sites for these species, the pools of water generated by discarded plastic are usually small, and host very little insect diversity. Plastic waste might thus help to decrease predation of mosquito larvae, increasing their survival rate and density.Indirectly, the accumulation of plastic debris can clog water drainage, leading to a flood of stagnant waters after heavy rains. Resulting pools can serve as a breeding ground for disease vectors such as Anopheles mosquitoes, potentially increasing the malaria burden of an area.50Adane L Muleta D Survey on the usage of plastic bags, their disposal and adverse impacts on environment: a case study in Jimma City, Southwestern Ethiopia.J. Toxicol Environ. 2011; 3: 234-248Google Scholar, 51Boadi KO Kuitunen M Municipal solid waste management in the Accra metropolitan area, Ghana.Environmentalist. 2003; 23: 211-218Google Scholar, 52Kibret S Wilson GG Tekie H Petros B Increased malaria transmission around irrigation schemes in Ethiopia and the potential of canal water management for malaria vector control.Malar J. 2014; 13: 360Google Scholar Not only do discarded plastics provide a suitable breeding ground for their larvae, but they also can provide shelter for other haematophagous arthropods, such as triatomine bugs responsible for Chagas disease.53Dumonteil E Nouvellet P Rosecrans K et al.Eco-bio-social determinants for house infestation by non-domiciliated Triatoma dimidiata in the Yucatan Peninsula, Mexico.PLoS Negl Trop Dis. 2013; 7e2466Google Scholar, 54Rosecrans K Cruz-Martin G King A Dumonteil E Opportunities for improved chagas disease vector control based on knowledge, attitudes and practices of communities in the Yucatan Peninsula, Mexico.PLoS Negl Trop Dis. 2014; 8e2763Google ScholarBeside arthropod-borne diseases, stagnant pools of water generated by plastic waste can promote waterborne diseases such as trematodiasis,55Keiser J Utzinger J Emerging foodborne trematodiasis.Emerg Infect Dis. 2005; 11: 1507-1514Google Scholar dracunculiasis (also known as Guinea worm disease), schistosomiasis (also known as bilharzia), lymphatic filariasis, and onchocerciasis.56Fenwick A Waterborne infectious diseases—could they be consigned to history?.Science. 2006; 313: 1077-1081Google Scholar For schistosomiasis, freshwater snails, such as Bulinus spp or Biomphalaria spp act as intermediate hosts, and can lay their eggs in discarded plastics.57Stothard JR Campbell SJ Osei-Atweneboana MY et al.Towards interruption of schistosomiasis transmission in sub-Saharan Africa: developing an appropriate environmental surveillance framework to guide and to support 'end game' interventions.Infect Dis Poverty. 2017; 6: 10Google Scholar Similarly, macroplastic debris can generate suitable habitats for these molluscs, with the potential to locally increase the disease burden. The same is observable for leptospirosis where Leptospira interrogans, which is responsible for leptospirosis, was able to develop a biofilm on plastic in an in vivo model.58Brihuega B Samartino L Auteri C Venzano A Caimi K In vivo cell aggregations of a recent swine biofilm-forming isolate of Leptospira interrogans strain from Argentina.Rev Argent Microbiol. 2012; 43: 7Google Scholar, 59Harrison JP Schratzberger M Sapp M Osborn AM Rapid bacterial colonization of low-density polyethylene microplastics in coastal sediment microcosms.BMC Microbiol. 2014; 14: 232Google Scholar, 60Kirstein IV Kirmizi S Wichels A et al.Dangerous hitchhikers? Evidence for potentially pathogenic Vibrio spp. on microplastic particles.Mar Environ Res. 2016; 120: 1-8Google Scholar Similarly, a plethora of organisms building up complex biofilms can rapidly colonise floating plastic and harmful algae and bacteria such as Vibrio spp (responsible for cholera) can develop on plastic debris.59Harrison JP Schratzberger M Sapp M Osborn AM Rapid bacterial colonization of low-density polyethylene microplastics in coastal sediment microcosms.BMC Microbiol. 2014; 14: 232Google Scholar, 60Kirstein IV Kirmizi S Wichels A et al.Dangerous hitchhikers? Evidence for potentially pathogenic Vibrio spp. on microplastic particles.Mar Environ Res. 2016; 120: 1-8Google Scholar Since this material is resilient for a long time in the environment, it can act as a vessel in propagating infectious bacterial and algae species.60Kirstein IV Kirmizi S Wichels A et al.Dangerous hitchhikers? Evidence for potentially pathogenic Vibrio spp. on microplastic particles.Mar Environ Res. 2016; 120: 1-8Google Scholar Finally, waterborne diseases generated from leftover plastic also affect livestock, potentially holding back agricultural development and local income, and potentially stimulating zoonotic diseases.61Conan A Ponsich A Luce Goutard F et al.A community-based education trial to improve backyard poultry biosecurity in rural Cambodia.Acta Trop. 2013; 125: 294-302Google Scholar For example, locally removed plastic waste led to a substantial increase in survival rate for poultry, a major source of protein in low-income countries, attributed to a decrease of salmonellosis and pasteurellosis (fowl cholera) cases.62FAORural livelihood and biosecurity of smallholder poultry producers and poultry value chain. Gender and socio-economic impacts of highly pathogenic avian influenza (HPAI) and its control in Siem Reap Province, Cambodia.http://www.fao.org/docrep/013/al681e/al681e00.pdfDate: 2009Date accessed: September 21, 2021Google Scholar Known to also be influenced by climate change,63Guerra MA Leptospirosis: public health perspectives.Biologicals. 2013; 41: 295-297Google Scholar incidence of waterborne diseases is likely to increase substantially with the concomitant increase in plastic debris.Discarded plastics offer a favourable habitat for vector species, by providing a suitable habitat for the development of their immature stages, locally increasing the density of vectors, and by providing the adults with shelter. In addition, the pools of water that collect in or due to plastic waste can sustain waterborne diseases, such as schistosomiasis, leptospirosis, cholera, or salmonella, causing a burden on both humans and livestock living nearby. Considering the rapidly growing generation of plastic waste, the burden caused by these infectious diseases will probably rise. By 2050, 70% of the world's population will live in urban areas64Angel S Atlas of urban expansion. Lincoln Institute of Land Policy, Cambridge, MA, USA2012Google Scholar and without much more effective waste management strategies, especially in tropical areas, more people will likely be exposed to infectious diseases. A global sanitary crisis such as COVID-19 shows how rapidly additional disposable sanitary plastic elements can be created65Benson NU Fred-Ahmadu OH Bassey DE Atayero AA COVID-19 pandemic and emerging plastic-based personal protective equipment waste pollution and management in Africa.J Environ Chem Eng. 2021; 9105222Google Scholar, 66Patrício Silva AL Prata JC Walker TR et al.Increased plastic pollution due to COVID-19 pandemic: challenges and recommendations.Chem Eng J. 2021; 405126683Google Scholar, 67Patrício Silva AL Prata JC Walker TR et al.Rethinking and optimising plastic waste management under COVID-19 pandemic: policy solutions based on redesign and reduction of single-use plastics and personal protective equipment.Sci Total Environ. 2020; 742140565Google Scholar and how subsequent, efficient, waste management strategies have failed. By lacking suitable plastic waste management systems, many middle-income countries might have controlled one disease, but could have put their poorest populations at risk with another major sanitary problem in the form of arthropod-borne or waterborne diseases. Globally, plastics lack a circular economy4Jambeck JR Geyer R Wilcox C et al.Marine pollution. Plastic waste inputs from land into the ocean.Science. 2015; 347: 768-771Google Scholar that would encourage a more responsible and sustainable management.4Jambeck JR Geyer R Wilcox C et al.Marine pollution. Plastic waste inputs from land into the ocean.Science. 2015; 347: 768-771Google Scholar, 68Ezeah C Roberts CL Analysis of barriers and success factors affecting the adoption of sustainable management of municipal solid waste in Nigeria.J Environ Manage. 2012; 103: 9-14Google Scholar, 69Kinnaman TC The economics of municipal solid waste management.Waste Manag. 2009; 29: 2615-2617Google Scholar, 70Magalini F Global challenges for e-waste management: the societal implications.Rev Environ Health. 2016; 31: 137-140Google Scholar, 71Oguntoyinbo OO Informal waste management system in Nigeria and barriers to an inclusive modern waste management system: a review.Public Health. 2012; 126: 441-447Google Scholar, 72Zhou Z Tang Y Dong J et al.Environmental performance evolution of municipal solid waste management by life cycle assessment in Hangzhou, China.J Environ Manage. 2018; 227: 23-33Google Scholar As plastic pollution affects the environmental–human–animal health triad, any solution will require a One Health approach.Overall, the influence of plastic waste on infectious disease maintenance and emergence is underestimated. This lack of knowledge and understanding is due to the absence of dedicated transdisciplinary and transboundary